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Waltham Forest Practice Support Search

Manual 2017 - 2018

CKD Project

Latent TB Screening

Diabetes Recall

Online Diabetes education Programme

Clinical Tools

Prevalence Improvement

DES Support

Immunisations

Miscellaneous

QOF Support

A guide to all the

searches you need for

improving income &

quality in 2017-18

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Introduction to support searches

This document details the list of CEG searches that are available to practices to use to support a number of services. The searches are located in Population Reporting under ‘Tower Hamlets Clinical Effectiveness’ domain in ###Waltham Forest Practice Support folder. They are designed to help as many people as possible; if you feel that they would work better in your case by changing certain parameters, feel free to copy and edit them (by changing date criteria for example). From time to time, you will receive emails or RSS feeds informing you that a search has been updated or a new search has been added. When this happens you need to delete the old search and copy and paste the new one into your domain. At the moment of publishing this document (3rd Nov 2017), the latest versions are as follows:

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Symbols

Indicates a folder Indicates that this is a SEARCH (it will produce a list of patients)

If a search or report is indented this means it is a child search (the sum of the patients

included and excluded in this search will be the total of patients included in the parent search)

Indicates that this is a REPORT (it will produce a more complex spreadsheet, typically with fields

such as patient details, diagnoses, medication, specific codes, etc.)

Abbreviations CKD – Chronic Kidney Disease DES = Directed Enhanced Service COVER = Cover of Vaccination Evaluated Rapidly Rx = Prescription H/O = History of SMI = Serious Mental Illness LVD = Left Ventricular Dysfunction PPA = Prescription Pricing Authority, now replaced by NHS Business Services APL – Active Patient Link (brand name for CEG smart clinical tools)

Relative Run Date

When you run a search by just clicking ‘Run’, all data will be included up to the moment you are running it. So, if you are running it at 10am on the 12th December, and the search criteria says that it should search for the last month, it will include codes dated from 10am on the 12th November.

But more often you need to know data in relation to a particular month. For example, how many of certain procedures you carried out in November. To this effect, you would use a search with last 1 month

criteria, and set your relative run date on the 1st of December. This will include all the data for the month of November and nothing else.

To do this, you click ‘Run’, the click ‘Advance Options’, and choose the relative run date that you need in the calendar.

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Practice Support Searches & Reports

1. - *CKD Project (renal dashboard) v1

Evidence of CKD

1.1 QOF coded v33 [REVIEW EXCLUDED]

1.2 With b/p below 140/90 [REVIEW EXCLUDED]

1.3 On statins

1.4 Not on statins, no contraindications or decline [REVIEW INCLUDED]

Referrals to renal virtual clinic from 1st November 2016

The CKD Project searches will help you identify and manage patients that could potentially have CKD stage 3-5, which will then put the patient on your QOF register. (NB: If a patient has stage 1 or 2 CKD this does not qualify for the QOF register)

Evidence of CKD – will show any patients that have 2 eGFR’s 90 days apart under 60 (ethnicity corrected for afro-Caribbean)

Search 1.1 – Review the excluded list, this will help you identify the patients that have a Kidney disease code but it is NOT QOF compliant.

Search 1.2 – When you review the excluded list it will identify all patients that currently do not have a controlled BP.

Search 1.3 – This will show you any patients on a statin that has CKD.

Search 1.4 – Review the included list, this is a follow on from search 1.3, it will narrow down the patients that can be put on a statin as they have no contraindications coded or decline code.

The final search will show any patients that you have referred to the virtual clinic by coding Referral to community nephrology clinic (EMISNQRE498). You can also tick the referred box in the CKD Waltham Forest CEG template which will code the referral in the patient’s record.

2- ** Latent TB Screening 2017-18 v3 Currently eligible for Latent TB Screening [CALL IN]

Possibly eligible for Latent TB Screening [check date of entry] The Latent TB searches will help you identify and manage patients that are 16-35 years old, from a high risk country and entered the country in the last 5 years. For these searches to work you would need to record the country of birth, you can do this by using the New Patient Check Waltham Forest CEG template.

Currently eligible for Latent TB Screening – You will need to review the included list and call all these patients and offer them the IGRA blood test. Once the test has been offered, and when you receive the result, you can record this in the New Patient Check Waltham Forest CEG template.

Possibly eligible for Latent TB Screening – You will need to check the date of entry for these patients and then if it is within the last 5 years they will need to be offered the IGRA test.

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3- *** Diabetes recall Current Diabetic Register

1- Patients due diabetic annual review next month

2- Pts with no diary entry next m but with annual review 11m ago

3- Pts with last diab foot check 11m ago (proxy for review)

4- Pts with NO diab foot check in 2017-18 [Look ahead]

The diabetes recall searches are all looking for the same outcome, any diabetic patients due a review. We have done this search in multiple ways as some practices do not always code annual review done, and/or diary entry. Some patients might be picked up in multiple searches depending on the coding at the practices. You will need to view the included list for all the searches.

4- **** Online diabetes education programme v1 Online diabetes education programme possible candidates

Contact details

Online diabetes education programme possible candidates (with HbA1c done recently)

Contact details

Online diabetes education programme is for any Diagnosed Type 2 Diabetic in the past 12 months, age 18+, BMI of 25 or above, not insulin treated and are not pregnant. You might want to priorities those patients who have already had a test for HbA1c recently to save them a trip to the surgery. These searches will help you identify who these are. Whichever search you decide to use, you will need to use the included list. The report falling off the search will give you the list of patients’ names and their contact details.

5- Clinical Tools

Falling eGFR v1 Falling eGFR

Falling eGFR (2)

You will need to run the Falling eGFR search and report (ignore the search result and export the CSV file from the Falling eGFR (2) report) you then import the CSV file to the Falling eGFR trigger tool, this would have been emailed to you, this identifies patients who have had a fall of 10 or more from previous value so that you can promptly refer them for specialist assessment in the e-renal clinic if necessary.

Always set the relative run date to the 1st of the current month. This will audit the previous month only.

Waltham Forest CCG have then asked once you have completed the tool on a monthly basis you email the report to them, patient anonymised, to renal@walthamforestccg.nhs.uk

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6- Prevalence Improvement Asthma

A01- On preventer inhalers (repeat Rx), no asthma or COPD code, age 16+

A02- On preventer inhalers (repeat Rx), no COPD, coded asthma resolved

Atrial Fibrillation

AF01- ECG shows AF or H/O code but not on AF register

AF02- Irregular Pulse

AF03- On Warfarin but not on AF register

AF04- On NOAC but not on AF register

AF05- Monitoring code but not on AF register

Cancer

CA01- Non QOF cancer codes added since 1 Apr 2016

CHD

CH01- On Nitrates but not on CHD register

CH02- Non QOF CHD codes

CH03- H/O codes but not on CHD register

CKD

CK01- Latest eGFR 1-29 but not on CKD register

CK02- Latest eGFR 30-45 but not on CKD register

CK03- Renal disease code and low eGFR but not on CKD register

eGFR evidence of CKD

CK04- Not coded as QOF CKD, but evidence on CKD

COPD

CO01- COPD case finding – age over 50 (smokers last 15m)

CO02- COPD case finding – age 40-50 (smokers last 15m)

CO03- On Tiotropium but not on COPD register

CO04- MRC 4 or 5 but not on COPD/Asthma/HF register

CO05- FEV1 under 65 but not on COPD/Asthma register

CO06 – Monitoring codes but not on COPD register

Dementia

DEM01- Non QOF codes

DEM02- On meds, not on register

DEM03- Dementia tests not normal, not in QOF

DEM03.1 exclude those referred on

DEM04- Referral to memory clinic or psychogeriatrician

DEM4.1 exclude those with memory found normal / mildly impaired after referral

Depression

DEP01- Non QOF depression codes, on antidepressants, excl SMI & PMS

Diabetes

D01- On insulin, no GD, but not on Diabetes register

D02- On Metformin, no PCOS, no GD, but not on Diabetes register

D03- HbA1c=>48, not GD, not on diabetes register

D04- Diabetes but not coded as for QOF register

Epilepsy

EP01- Monitoring codes but not on Epilepsy register

EP02- On meds, plus seizures but not on Epilepsy register

Heart Failure

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HF01- Heart Failure case finding

HF02- LVSD but not on HF register

HF03- HF with no LVD

HF04- H/O HF code but not on HF register

HF05- Monitoring code but not on HF register

Hypertension

HY01- Last 3 BPs >=160/100 but not on Hypertension register

HY02- Last 3 BPs 140-159/90-99 plus comorbidity but not on Hypertension register

Learning Disabilities

LD01- Down’s syndrome but not on LD register

LD02- Monitoring or cause code but not on LD register

PAD

PAD01- PAD codes, not in QOF register

Stroke

S01- H/O Stroke/TIA code but not on Stroke register

S02- Monitoring code but not on Stroke register

Please see Appendix 1 for more information on how to use these searches. It includes instructions on how to combine searches.

7- DES Support

Learning Disabilities reviews v2

** Patients on the Learning Disability Register(DES – age 14+)

LD HAP done in the last 12m

LD review done in the last 12m

Notes

For patients on the learning disability register they are due a review on a yearly basis and a Health Action Plan to be completed.

Patients on the Learning Disability register – if you view the included list this will inform you of all the patients on the register.

LD HAP done in last 12m – view the excluded list and it will show patients on the register but haven’t had the Health Action plan completed in the past 12m.

LD review done in last 12m – You need to review the excluded list again to look at the patients that are on the register but have not had a review done in last 12m.

8- Immunisations COVER Audit Child Immunisation Recall v9

001 6-12 months old Cohort

12 months olds Cohort Imms details

002 12-24 months olds Cohort

24 months olds Cohort Imms details

003 3y4m to 5 years olds Cohort

5 year olds Cohort Imms details

004 6-12 months old Cohort

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12 months olds NOT fully immunised

005 12-24 months olds Cohort

24 months olds NOT fully immunised (Men B not considered)

006 3y4m to 5 year olds Cohort

5 year olds NOT fully immunised

Notes

Pertussis vaccination in pregnancy coding v3

PV01- Patients who have been pregnant in last 9 months and still pregnant

PV02- Delivery since 1 Apr 17 (excluding premature)

PV03- Currently pregnant or delivered after 1 Apr 17

PV04- Exclude correct payment code added since 1 Apr 17

PV05- Coding suggests Pertussis vac given [ADD code 6556]

Cover Audit Child Immunisation Recall: The reports will list every child in the cohort with the vaccinations they have been given so far. The blank cells will indicate that the vaccination that is supposed to appear in the column has not been given. Be careful to always check the medical record: although we have tried to accommodate the different vaccination schedules used for children who started their lives abroad, it has not been possible to provide for a 100% of those cases. Always check with an experienced clinician. The following chart will help you when in doubt: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/652156/PHE_vaccination_algorithm_individuals_with_uncertain_or_incomplete_immunisation_status.pdf

The searches give you list of patients not fully immunised but do not provide you with all the details that the reports do.

9- Miscellaneous

Bowel Cancer Screening Programme v5

FOBT Incomplete participation

FOBT Spoilt

No response to invitation

Turning 60 month before

Oral Nutritional Supplements

ONS prescribed in last 12m ONS prescribed in last 12m

PPA Claims Support v1

PPA Flu Script needed PPA Flu

PPA Injections PPA Injections

PPA Pneumococcal Script needed PPA Pneumococcal

PPA Travel- Hepatitis A or A Combined Script needed

PPA Travel- Hepatitis B Script needed

PPA Travel- Meningitis A Script needed

PPA Travel- Typhoid Script needed

The PPA Claims Support searches help you identify patients where a code indicates that a vaccination has been given but a prescription has not been issued, thus losing you money. You can run the searches, issue the

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prescriptions you need to issue (with the correct date, not today’s date!) and run the FP34D report again before submitting it.

Always set the relative run date to the first day of the month following the month you are auditing, e.g. if you

are preparing October’s claim, set the relative run date as 1st

November.

10- Miscellaneous Expiring exceptions for meds or bp in the past v3

Expiring exceptions for AF the year before

Expiring exceptions for CHD the year before

Expiring exceptions for diabetes the year before

Expiring exceptions HF the year before

Expiring exceptions for Hypertension the year before

Expiring exceptions for PAD the year before

Expiring exceptions for stroke-TIA the year before

OST004-Osteoporosis Register (as defined by QOF)

Expiring exceptions for osteoporosis the year before

Osteoporosis

OST01-Aged 75+, fragility # from 1Apr14, no osteo diagnosis

OST02- Aged 75+, #, but no fragility # from 1Apr14

OST03-Aged 50-74, fragility # from 1Apr12, osteo diag NO DEXA

OST04-Aged 50-74, fragility # from 1Apr12, no osteo diagnosis

OST05-Aged 50-74, #, but no fragility # from 1Apr12

OST06-Aged 50-74, no bone meds, with osteoporosis and #, but no fragility #

OST07-Aged 75+, on bone meds, with osteoporosis and #, but no fragility # (2)

Expiring codes: EMIS already provides you with searches to identify patients who were exception reported for the whole register the year before, so that you can decide if you need to do the same this year. They appear in folders called ‘Supplementary searches’ in every register of the GP Contract – QOF searches.

Our new set of searches is an addition to the EMIS facility. There will be patients who do not merit exception reporting from the whole register but only for certain metrics, e.g. ‘PAD and on antiplatelet’. Here you can find those you exception reported in 2016/17 (but not this year so far) in case the reasons why you did it still apply and you need to exception report them again.

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Appendix 1: Prevalence Improvement searches Why it is important to make sure your recorded disease prevalence is correct

Crucially, if a patient suffering from a chronic condition is not appearing in your QOF register, they may ‘fall off the radar’, that is, they might miss on their reviews and other important aspects of their clinical care.

From a financial point of view, recorded disease prevalence is used to calculate how much you get paid for your QOF points. Below average prevalence results in below average pounds per point.

If an area under records clinical prevalence for a particular conditions, less resources might be allocated to care for patients with that condition in the area.

The rationale of the CEG Prevalence Improvement searches What we are trying to do with these searches is find ‘clues’ that maybe the patient should be in a particular disease register but isn’t. In this sense, we have four different types of searches:

Review codes. For example: patients who have a ‘Stroke annual review’ code in their record but do not appear in the QOF Stroke register.

H/O codes. For example: ‘H/O atrial fibrillation’. This kind of code is not a diagnostic code and does not put a patient in the register.

Medication. For example: patients on Tiotropium who are not on the QOF COPD register.

Values. For example: patients with an eGFR value under 30 recorded who are not on the QOF CKD register.

Please note that these searches are not like a test where you need to reach a target of zero. There will often be good clinical reasons why a patient is not in a particular register. However, if the current code on the patient record is incorrect, it is important to delete it following practice protocol. For example, it would be inappropriate to have a ‘H/O stroke’ code in the record of a patient who has never had a stroke. On the other hand, if it turns out that the patient did have a stroke, it is essential to enter the Stroke code with the date of when it actually happened – never today’s date! Naturally, going through these lists of patients will involve studying their medical records (often digging up the Lloyd George!) and making clinical decisions.

Combining searches

If you prefer to have just one list of patients for each register, you can combine the searches into one by following these steps: Select the disease folder and ‘Add search’

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I have named my search ‘Combined’

Select ‘use an existing search’s results’ and browse until you find the 1st search you want to combine.

Then ‘add another rule’ and again Select ‘use an existing search’s results’ and browse until you find the 2nd

search you want to combine.

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You want patients who are in either one or the searches so you need to make sure the settings are ‘OR’ rather than ‘AND’

Save and you are done. The resulting search definition will look like:

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Visit the CEG Website:

http://www.blizard.qmul.ac.uk/ceg-home.html

Clinical Effectiveness Group Centre for Primary Care & Public Health Blizard Institute

Queen Mary University of London London